Deep Brain Stimulation Effective Treating OCD

Damiaan Denys, MD, PhD

While deep brain stimulation is effective for patients with refractory obsessive-compulsive disorder (OCD), the clinical experience of this treatment is limited in this patient population.

A team, led by Damiaan Denys, MD, PhD, examined the tolerability and effectiveness of deep brain stimulation for patients with refractory obsessive-compulsive disorder.

The study included 70 consecutive patients, 16 of which participated in a previous study. Each patient received bilateral deep brain stimulation of the ventral anterior limb of the internal capsule (vALIC) between April 2005 and October 2017.

Each patient was followed for 12 months.

The investigators assessed primary effectiveness by the change in scores on the Yql3-Brown

Obsessive Compulsive Scale (Y-BOCS) from baseline until the 12-month follow-up.

They also defined response as a ≥35% decrease in Y-BOCS score, while partial response was defined by a 25%−34% decrease and nonresponse was defined by a <25% decrease.

The team measured secondary effectiveness using the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D).

Ultimately, they found Y-BOCS, HAM-A, and HAM-D scores all decreased significantly during the first 12 months of deep brain stimulation by 13.5 points (SD = 9.4) (40% reduction; effect size = 1.5), 13.4 points (SD = 9.7) (55%; effect size = 1.4), and 11.2 points (SD = 8.8) (54%; effect size = 1.3), respectively.

After the 12-month follow-up, 36 of the 70 patients were categorized as responders (52%), while 12 patients were labeled as partial responders (17%), and 22 patients were deemed nonresponders (31%).

Patients also reported various adverse events, including transient symptoms of hypomania, agitation, impulsivity, and sleeping disorders.

However, deep brain stimulation was deemed safe and effective.

“These results confirm the effectiveness and safety of [deep brain stimulation] of the vALIC for patients with treatment-refractory OCD in a regular clinical setting,” the authors wrote.

investigators suggest a need for more individualized approaches to defining mental illnesses because of substantial overlap across different disorders.

A team of investigators, led by Claire M. Gillan, PhD, School of Psychology, Trinity College Institute of Neuroscience and Global Brain Health Institute, recently completed a 285-patient cross-sectional study in the US for individuals diagnosed with obsessive-compulsive disorder and/or generalized anxiety disorder (GAD).

The investigators found self-reported compulsivity was more strongly linked with goal-directed deficits than a diagnosis of OCD compared with GAD.

The results could have implications for research assessing the association between brain mechanisms and clinical manifestations, as well as for understanding the structure of mental illness.

The aim of the study was to identify if deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder. Each patient completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments between 2015-2017.

A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (P&thinsp;=&thinsp;.18), but a compulsivity dimension was negatively associated with goal-directed performance (P&thinsp;=&thinsp;.003).

The study, “Efficacy of Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Refractory Obsessive-Compulsive Disorder: A Clinical Cohort of 70 Patients,” was published online in The American Journal of Psychiatry.